Archived: Satellite Consortium Limited

This service was last inspected on 28 September and 27 October 2016 where it was rated Requires Improvement. At the last inspection we found the provider to be in breach of four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations relating to mental capacity assessments, risk medicines administration, staff training, staff supervision and governance. After that inspection, the provider sent us an action plan to say what they would do to meet legal requirements in relation to the breaches.

At this inspection we found that the provider had not fully followed their plan, which they had told us would be completed by February 2017. The provider had not addressed the breaches of the abovementioned regulations and there were repeated breaches in relation to the need for consent, safe care and treatment, staffing and good governance.

The service did not have a registered manager in post. The provider had appointed a new manager who was undergoing the registration process with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider did not identify, assess and mitigate risks associated with people’s health, care and mobility needs. Staff were not provided with sufficient information around risks involved in supporting people and how to minimise those risks to provide safe care. The associated care plans were not individualised and regularly reviewed. Staff were not provided with comprehensive and up-to-date information about people’s needs or how to support people safely whilst meeting their individual health and care needs. The provider did not maintain appropriate medicines administration records (MARs) for people who were supported with medicines administration and prompting. People’s care plans did not make reference to their mental capacity to make their own decisions. The provider did not effectively monitor staff punctuality and timekeeping, and missed and late visits were not recorded.

The provider did not notify us of two safeguarding cases. Not all staff received safeguarding training and staff lacked understanding of how to identify and report abuse. Safeguarding records did not give details on the investigation outcomes.

The provider did not follow safe and appropriate staff recruitment practices. Some staff recruitment checks including criminal record and reference checks were not in line with the provider’s policy.

Staff were not provided with induction training before they started working with people. Staff did not receive regular supervision, yearly appraisals and refresher training to enable them to do their jobs effectively.

People were encouraged to raise concerns and complaints. Staff told us they investigated people’s complaints but these were not recorded and there were no records of the investigation outcomes and lessons learned.

The provider did not maintain effective data management and monitoring systems to assess the quality and safety of care delivery. The provider was not auditing systems and processes related to care that was being provided including daily care logs and MARs. The provider had not analysed the feedback from people’s annual survey and had not identified areas of improvement.

People and their relatives told us staff were caring and helpful and treated them with dignity and respect. Staff were not trained in equality and diversity and dignity in care. People told us they generally received care from the same team of staff. People were happy with nutrition and hydration support.

We found the registered provider was not meeting legal requirements and there were seven breaches of the Health and Social Care Act 2008 (Regulated Activities regulations. These were in relation to the need for consent, safe care and treatment, safeguarding service users from abuse, acting on complaints, staff training and supervision, fit and proper persons employed, and for systems and processes to improve the quality and safety of the services including maintaining accurate records. We also found one breach of regulation 18 (Registration Regulations 2009) in relation to the notifications of other incidents.

Full information about CQC’s regulatory response to any concerns found during inspections is added to the back of the full version of the reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made signification improvements within the timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

Prior to this inspection the service was inspected in July 2013 when the service met all the standards inspected with the exception of ‘Safeguarding people who use the service from abuse’ as some action was required. A focussed inspection with regard to this standard was carried out in January 2014 when the standard was met by the service.

The service was providing personal care to 60 people at the time of our visit. They support people with dementia, a physical disability, learning disability or autistic spectrum disorder, sensory impairment and older people in their own homes. The service specialises in providing culturally specific care and support to people from ethnic minority backgrounds in the London Borough of Haringey.

There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found four breaches of the regulations. The service did not have robust systems for the administration and auditing of medicines. The service undertook risk assessments that minimised risks to people but these were not updated on a regular basis. The service was not undertaking mental capacity assessments or holding best interest meetings in accordance with the Mental Capacity Act 2005. We found that not all staff were receiving regular supervision sessions and training needs were not being identified for individual staff members. Although we found the registered manager was working with a training agency to address this issue. We found that there were not effective systems of governance in place to ensure people’s records were updated. Although the agency asked for service user feedback there were not sufficient checking measures in place to ensure for example that all staff attended calls at the times specified.

However people and their relatives spoke very highly of the care provided both by the registered manager and the care staff. The service provided continuity of care as they matched care staff to people and ensured they introduced replacement care staff when permanent staff were absent. The service specialised in providing care to different cultural groups in the authority and tried to match when possible people with care staff who spoke the same language and knew how to cook appropriate culturally specific meals. People described care staff as friendly, caring and respectful.

People had detailed care plans that gave good clear guidance to staff and specified how many staff were required, tasks to be undertaken, the days and times of the visits. People felt able to call the office and discuss if they required changes to their care plan. We saw the management team responded to people’s requests.

People were supplied with a service user handbook and felt empowered to raise concerns and complain where necessary. We saw that the registered manager responded quickly to concerns and addressed matters speedily aiming for a positive resolution.

The service was working in partnership with the commissioning body to ensure they were meeting the changing needs of the community.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12 Safe care and treatment, Regulation 11 Need for consent, Regulation 18 Staffing and Regulation 17 Good governance.

You can see what action we told the provider to take at the back of the full version of the report.

At our current inspection we found the provider was now meeting this standard.

'We've been using them for a long time and have not had any problems at all.'

'Sometimes there is a lack of communication. Messages don't always get shared.'

'Some of the carers are very good. Others are less good.'

'We've had no complaints.'

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights.

People who use the service were not protected from the risk of abuse because the provider did not have up-to-date policies and procedures in place to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had a system to regularly assess and monitor the quality of service that people receive.

We spoke with four members of staff and three people or their relatives who were receiving care.

The people or their relatives told us that they felt the service was good and that the main carers they had were good. For example one person told us that they had a 'quality service'. However, two of the people we spoke with told us they had concerns that the staff providing care did not always turn up on time. One person also told us they felt that when staff were required to cover a shift because the normal carer was not unable to, they did not always have the necessary knowledge to do so.

Our inspection of 2 July 2012 found there was no evidence that all staff were receiving supervision. The provider also did not have a system in place to record the time elapsed since previous monitoring visits and ensure that monitoring visits were conducted to all people using the service. On our inspection of 8 and 12 March 2013 we found this was still the case. The provider did not have systems to ensure all staff were receiving supervision or that monitoring visits were taking place.